infosociety vaaka

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FIN-EST TWINNING II KICK OFF SEMINAR 21 May 2003
TALLINN EU OBJECTIVES AND PERSPECTIVES FOR
OCCUPATIONAL HEALTH Professor Jorma Rantanen,
Finnish Institute of Occupational Health
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POLICY
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EU policyEnlargement

• Agenda 2000 13 countries applied the membership.
  Acquis Communitaire required i.e. accession
  criteria. Several requirements and tasks to OHS.
• Enlargement will be made by supporting the
  applicant countries to achieve the minimum level
  of OHS as defined by the Acquis Communaitaire
• Phare economic and expert support and twinning
  instruments will be used to implement that
  principle.
• Copenhagen Summit 2002 10 countries will join in
  April 2004

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EU policy

• Policy
• Amsterdam Treaty
• Lisbon Strategy Quality of work
• OSH Strategy 2002-2006
• Public Health Programme
• Technology Programme
• Principles
• Strong social dimension
• High level of protection
• Social dialogue
• Primary prevention
• OH and OSH integration
• Employersprimary responsibility
• Participation

• Instruments
• Framework Directive
• 20 Daughter Directives
• OELs and standards
• HSMS
• MDS guideline
• List of ODs
• Other guidelines
• Topic Centers
• Dublin Surveys
• HS Week campaign

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Framework Directive 89/391 EEC

• Basic instrument for safety and health at work
• Defines responsibilities and rights of employers
  and workers at work
• Provides basic principles for safety and health (
  and more for safety than health)
• High level of protection
• Primary prevention at source
• Best available technology
• Right to know and right to get
  trained
• Right to participate
• Right to protective and preventive
  services
• Complemented with numerous specific daughter
  directives, standards and guidelines

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Community Strategy on Health and Safety at work
2002 - 2006

• Strategy objectives and actions
• For a global approach to well-being at work
• Strengthening the prevention culture
• Education, awareness, anticipation improving
  peoples knowledge of risks
• Better application of existing law
• Combining instruments and building partnership
• Adapting the legal and institutional framework
• Encouraging innovative approaches
• Working to mainstream health and safety at work
  in other Community policies
• Preparing for enlargement
• Developing international cooperation

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Investing in quality
Social Social quality - social cohesion
EU Strategy on OHS 2002-2006
Economic Competitiveness - dynamism
Employment Full employment - quality of work
Source. European Commission 26.6.2001
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RISKS
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Exposures to various WE factors in 1997 and 2000
in Finland (Source Piirainen et al
2000)
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Exposures to various WE factors in the EU in
1995 and 2000
( Source Paoli 20000 )

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Fatal accidents
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Risk of death in the years 198690 by age and
occupation in Finland (males) (Source Valkonen
et al. 1995)
Blue collars
Higher white collars
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Two levels of risk assessment

• Systems level

• Work place level
• Observations
• Reference values
• Context dependent
• Locally applicaple
• Based on codified practice
• Made by work place actors

• D-R relationship
• Generic standard
• Universally applicaple
• Based on research observations
• Takes place at national or international level
• Made by researchers

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General overview of EU risk assessment process
INFORMATION GATHERING

• EFFECTS ASSESSMENT
• Hazard identification
• Dose (concentration)-response
• (effect) assessment

• EXPOSURE ASSESSMENT
• Human exposure assessment (workers,
• consumers, via the environment)
• Environmental exposure assessment
• (water, soil, air)

RISK CHARACTERISATION
HUMAN HEALTH Evaluation of effects data and
comparison with exposure data
ENVIRONMENT Evaluation of effects data and
comparison with exposure data
OUTCOME OF RISK ASSESSMENT One or more of the
following conclusions/results
i) No immediate concern
ii) Further information needs
iii) Concern, recommendations for risk reduction
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Estimated asbestos-related cancer mortality per
100,000 by exposure level for a 20-year working
period (Source Nicholson, US Dept. Labor 1998)
Asbestos fibre concentration (f/ml)
Mortality/100,000 for 20 year exposed
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Workplace risk assessment
8. DEFINE OPTIONS FOR RISK ELIMINATION OR
MANAGEMENT
1. PROGRAMMING
2. PLAN THE ASSESSMENT MODEL
9. SET PRIORITIES, CHOOSE PRACTICES
3. FIND FACTS
10. IMPLEMENT
4. IDENTIFY HAZARDS
11. DOCUMENT
5. IDENTIFY PEOPLE AT RISK
12. MEASURE EFFICIENCY
13. CHECK AND COMPLETE
6. IDENTIFY THE ROUTES AND SOURCES OF
EXPOSURE
Improvement needed
Assessment Valid
7. ASSESS THE RISKS Probability
Severity
STOP
14. FOLLOW THE IMPACT OF RA
Present measuressufficient
Present measuresinadequate
No improvement
STOP
Improvement yes
STOP
15. MAKE RE-ASSESSMENT
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A simple health risk classification for chemical
and physical factors based on British standard BS
8800
Consequences/ Slightly harmful Harmful Extremely
harmful probability Discomfort,
irritation, Long-lasting serious Constant
serious effects, mild disease, draught, effects,
burns, life shortening diseases, small burns,
reddening frostbites, hearing poisoning,
work-related of the skin loss, vibration
white cancer, asthma, drowning, finger,
electric eye, loss of vision, heart skin
rashes attack Highly unlikely 1. Trivial risk 2.
Tolerable risk 3. Moderate risk less than 50 (no
action) (monitoring) (actions needed) of the
OEL Unlikely 2. Tolerable risk 3. Moderate
risk 4. Substantial risk 50-100
of (monitoring) (actions needed) (actions
necessary) the OEL Likely 3. Moderate risk 4.
Substantial risk 5. Intolerable risk exceeding
the (actions needed) (actions necessary) (instant
actions) OEL
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Those at risk of violence or threat of violence
during the past 12 months, by age groups, of
respondents (Source Piirainen et al. 2000)
women
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Risk factors of LBP and sciatica(Source
Heliövaara 1995)
Risk factor Strength of evidence

• Obesity
• Height
• Heavy work
• Car driving
• LBP
• sciatica
• Accidents
• Smoking
• Psychological stress
• Immobility

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Rates of accidents (total number/1000) and fatal
accidents/100 000 in the EU by age group
(EUROSTAT 1998)
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Incidence of 31 occupational diseases in the
Member States of European Union in 1995
(Karjalainen and Virtanen 1998)
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Work-relatedness of common chronic diseases

• Asthma (adult males) 30
  (Karjalainen et al, 2001)
• Lung cancer 25-30 (Axelsson 2001)
• Cardiovascular disorders
• CHD 5-10 (Leigh 1997)
• Cardiovascular 5 (Leigh 1997)
• Musculoskeletal disorders
• Upper extremities 15-40
  (EU OSHA)
• Low back pain 50 ?
  (NAS 2001)
• Total mortality 6.7
  (Nurminen
  
  Karjalainen 2001)

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SERVICES
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Workers covered by OHS in Europe(Source
Hämäläinen et al 2001, Rantanen 2002)

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INTEGRATED OHS SYSTEM
MOHS or MOL
DOHS
DOH
LABOURINSPECTORATE
IOH

OMCLINICS
OM
Private center
PHC
GROUP OHS
IN-COMPANY OHS
Big company
SME
Company
SE
SME
SSE
SME
SE
SE
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OH System for Kosovo (Rantanen,UNMIK and WHO 2000)
OHE occupational health expert IOH Institute
of Occupa- tional Health IPH Institute of
Public Health OHS Occupational Health Services
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Core content of OHS

• Surveillance of working conditions for health and
  safety aspects at work
• Assessment of risks to health and safety, risk of
  overload and stress
• Surveillance of health of workers and
  identification of work-related and occupational
  diseases
• Information of workers and management on health
  hazards at work and on how to prevent them
  including advice on safe and healthful working
  practices
• Advice on actions for preventive measures,
  control and risk management actions and for
  improvement of workers health
• Organization and maintenance of first aid
  readiness at the workplace

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Workers covered by OHS(Source Hämäläinen et al
2001)

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Finnish model for OHS
HEALTH, Work ability OHS,WHP
High quality work life
COMPETENCE and skill development
WORK ENVIRONMENT, Risk assessment, Risk
management Ergonomics Safety promotion etc.
WORK COMMUNITY, Participation, Working
cultures Work organization
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Health Promotion

• EMPLOYER
• Eliminating hazardous conditions
• Providing information
• and advice
• Organising facilities and
• enabling conditions
• Organising competitions and campaigns
• Following up the preogress
• Rewarding for success

• WORKERS
• Responsibility on ones own health
• Dedication to health and safety
• Joining in groups
• Following up progress
• Encouraging and supporting fellow workers
• Participating in collective campaigns
• "WHP Representative"

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Good occupational health practice (GOHP)
Professional competence experience, multidiscipli
narity
Scientific evidence, prediction and risk
assessment
Needs analysis Client participation
GOHP
Infrastructure, resources, coverage, operabi
lity
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CHANGE
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Rogers diffusion (1980)
degree of adoption
LAGGARDS
Late majority
Early majority
Early adopters
Innovators
Time
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Rule of law index and safety(Source World
Development Report 2000/2001)
GDP/CAPITA USD
30,000
Rule of law index
20,000
10,000
Fatal accident risk cases/100 000
2
1
0
Rule of law index
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Comprehensive OHSMWA Project at Dahlbo
Co(Source Näsman and Ahonen 1999)
Input costs 300 000 FIM/Yr
Benefits 10-fold
Reduction of sickness leave costs 200 000 FIM/Yr
Increased productivity 1,200 000 FIM/Yr
Reduction of work disability pension
costs 1, 600 000
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Economic benefits from PMWA (Source Peltomäki
et al 1999)
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Summary 21st Century

• Challenges to the Profession
• From care to prevention, promotion and
  development
• Broadening competence
• From OM to OH
• Multidisciplinary collaboration
• Maintaining professional leadership
• Self-evaluation
• Drawing from research

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Summary 21st Century

• OHS
• Work life will need OHS more than ever
• Full coverage of services need to be organized
• Content and competence of OHS need to be renewed
• New service provision models are needed
• Multidisciplinary, comprehensive approach
• OHS has been found productive in view of health,
  work ability and enterprise and national economy